First- and second-generation antipsychotic use in pregnancy and risks of pregnancy and birth outcomes.

This Danish population-based cohort study (2004-2022) asked whether continuing first- or second-generation antipsychotics during pregnancy is linked to gestational diabetes, gestational hypertension, and adverse birth outcomes compared with discontinuing them. Among 7,417 pregnancies, continuing second-generation antipsychotics was associated with non-significant trends toward higher gestational diabetes and hypertension (with the hypertension signal limited to high-metabolic-risk agents) and with lower odds of preterm birth, while first-generation continuation was linked to higher neonatal intensive care admission but not to maternal risk. The authors conclude that second-generation continuation carries maternal metabolic risk, whereas first-generation continuation is associated mainly with neonatal intensive care admission.